An angiography system of this type is known for example from U.S. Pat. No. 7,500,784 B2, and said system is explained below with reference to FIG. 1.
FIG. 1 shows a monoplane x-ray system presented by way of example with a C-arm 2 in the form of a six-axis industrial or articulated-arm robot supported by a stand 1, to the ends of which an x-radiation source, for example an x-ray emitter 3 with x-ray tube and collimator and an x-ray image detector 4 as an image recording unit are attached.
By means of the articulated-arm robot known from the above-mentioned U.S. Pat. No. 7,500,784 B2, which preferably has six axes of rotation and thereby six degrees of freedom, the C-arm 2 can be adjusted spatially in any given manner by being rotated for example around a center of rotation between the x-ray emitter 3 and the x-ray image detector 4. The inventive angiographic x-ray system 1 to 4 is especially able to be rotated around centers of rotation and axes of rotation in the C-arm plane of the X-ray image detector 4, preferably around the central point of the x-ray image detector 4 and around axes of rotation intersecting the central point of the x-ray image detector 4.
The known articulated arm robot has a base frame which is solidly mounted on a floor for example. Attached thereto is the carousel able to be rotated around a first axis of rotation. Attached to the carousel is a robot stand able to be pivoted around a second axis of rotation to which a robot aim able to be rotated around a third axis of rotation is attached. Attached to the end of the robot arm is a robot hand able to be rotated around the fourth axis of rotation. The robot hand has an attachment element for the C-arm 2, which is able to be pivoted around a fifth axis of rotation and is able to be rotated around a sixth axis of rotation running at right angles thereto.
The x-ray diagnosis device does not rely on industrial robots. Normal C-arm devices can also be used.
The x-ray image detector 4 can be a rectangular or square flat semiconductor detector which is preferably made of amorphous silicon (a-Si). However integrating and if necessary counting CMOS detectors can also be used.
Located in the beam path of the x-ray emitter 3 on a table plate 5 of a patient support table is a patient 6 to be examined as the object under examination. Connected to the x-ray diagnosis device is a system control unit 7 with an image system 8 which receives and processes the image signals of the x-ray image detector 4 (control elements are typically not shown). The x-ray images can then be viewed on displays of a monitor array 9.
Instead of the x-ray system presented by way of example in FIG. 1 with the stand 1 in the form of a six-axis industrial or articulated-arm robot, as shown in a simplified form in FIG. 2, the angiographic system can also have a normal ceiling or floor-mounted holder for the C-arm 2.
Instead of the C-arm 2 shown by way of example, the angiographic x-ray system can also have separate ceiling and/or floor-mounted supports for the x-ray emitter 3 and the x-ray image detector 4, which for example are electronically rigidly coupled.
These types of angiography system are used in the field of fluoroscopy-controlled interventional repair of abdominal aortic aneurysms.
An abdominal aortic aneurysm (AAA) is a vascular aneurysm on the abdominal aorta. This is treated by insertion of a stent graft. Guidewires and catheters are introduced into the aorta via both groins, via which one or more stent grafts i.e. plastic vessels, are introduced (see FIG. 3), as are shown for example in Cardiology today, January 2011, page 36, under “Product Guide: Guidewires”. The aim when introducing this stent graft is to place the “landing zone” of the vascular protheses as far as possible into the healthy vascular wall area, but in doing so not to cover over any important vascular branches. In particular to keep the branches of the liver arteries, the superior mesentenic artery (Arteria Mesenterica Superior), the truncus c(o)eliacus, and the internal pelvic arteries (A. iliaca interna) free. A sensible point is the placement of the “main stent” in the aorta in which the said vascular branches may not be closed off. With complex stents, which also include the leg arteries, the final stent must sometimes be assembled from “part stents”. For example a stent graft for the leg arteries is “flanged onto” an aorta stent graft, as is described below.
For this “flanging process” a guidewire is first introduced through an opening in the main stent. The part stent is then inserted via this and subsequently deployed, so that it is anchored tightly in the opening of the main stent. Above all the navigation of the guidewire into the narrow opening of the main stent can be problematic, since the two openings are not always aligned in parallel to the observer. Usually they are twisted around the aorta axis so that the opening to be hit is also located behind or in front of the other opening as seen by the observer.
What is desirable here is an angulation of the angiography system which accordingly freely projects the opening.
Previously the wire has been navigated using the standard angulations, for example a perpendicular a-p projection. In some cases better angulations have been found by users by “trial and error”.